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DOI: 10.1055/s-0045-1806148
Endoscopic biliary drainage in the palliative treatment of pancreatic tumors: results and predictive factors for success or failure
Aims Malignant pancreatic tumors are a highly aggressive form of cancer, offen asymptomatic in early stages and frequently diagnosed at an advanced, non-curative stage. As a result, the prognosis is extremely poor. Endoscopic biliary drainage via endoscopic retrograde cholangiopancreatography (ERCP) is the preferred palliative treatment, aimed at enhancing the quality of life for these patients. The aim of this study in a tertiary endoscopic center, is to report outcomes of endoscopic biliary drainage and to identify factors associated with the success or failure of this procedure.
Methods This is a retrospective descriptive study including all ERCP procedures performed for biliary drainage in patients with malignant pancreatic tumor over an 8-year period (May 2016–August 2024). Logistic regression analysis was used to identify factors associated with success or failure of the endoscopic procedure. Data analysis was performed with SPSS software (version 26).
Results Of the 2044 ERCPs performed during the study period in 1474 patients, 413 (20%) were performed for biliary drainage in 289 patients with pancreatic tumors. The mean age of the patients was 67.11±11 years (range: 31-98), and a sex ratio=1. The main indication for ERCP was acute angiocholitis (72%), followed by isolated jaundice in 66 patients (23%), and hepatic colic in (5%). The average total bilirubin level was 203 mg/L, accompanied by significative cholestasis and moderate cytolysis. Imaging revealed a pancreatic tumor with liver metastases in 18% of cases (n=52). The mean bile duct diameter was 18 mm±6 mm with bile duct stenosis identified in 71% of cases (n=206). First-attempt catherization and biliary stent placement were successful in 67% of cases (n=193), and the success rate after the second attempt was 72%. Reasons for failure included challenges in papilla catheterization, inability to pass the guidewire through stenosis, and duodenal invasion by the tumor. Multivariate analysis revealed that the presence of liver metastases, main bile duct stenosis, and duodenal invasion were significant predictors of endoscopic failure.
Conclusions Our findings suggest that ERCP remains a valuable option for palliative biliary drainage in patients with advanced pancreatic tumors, significantly improving their quality of life. Factors such as severe bile duct stenosis, duodenal invasion, and metastases appear to be associated with a higher risk of endoscopic failure, underlining the need for careful patient selection and alternative strategies in complex cases
Publication History
Article published online:
27 March 2025
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